Infliximab is arguably the first major advance in
therapy for
inflammatory bowel disease in more than a quarter of a century. Although it is important to distinguish efficacy from effectiveness, the data from clinical practice mirror those from randomized controlled trials.
Infliximab has proven efficacious for
luminal manifestations of
Crohn's disease (CD) regardless of location. It also has proven efficacy in the subset of penetrating disease to the skin and perianal area, and it increases rates of
steroid-free remission. These benefits are reflected in improved quality of life, with limited data showing that
infliximab can decrease rates of hospitalization and CD-related surgery.
Infliximab also has proven to be efficacious in patients with
ulcerative colitis (UC) and has increased rates of
steroid-free remission. Whether
infliximab will have an impact on the risk of
colorectal cancer in UC and Crohn's
colitis has yet to be determined. The combination of strong evidence from large randomized controlled trials with substantial examination of use in the practice setting has moved
biologic therapy with
infliximab from novel to mainstream. In this review, the data for the efficacy of
infliximab in controlled trials will be discussed in the context of real world effectiveness.